Clinical Prognostic Factors for Locally Advanced Esophageal Squamous Carcinoma Treated after Definitive Chemoradiotherapy
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Purpose Locally advanced esophageal cancers are generally treated with neoadjuvant chemoradiotherapy, followed by surgery in operable candidates. However, even if the patients were diagnosed as operable disease, surgery could not be performed on patients with poor condition or other comorbidity. In this case, definitive chemoradiotherapy (dCRT) is the other option for localized esophageal cancer. Therefore, the purpose of this study was to evaluate the efficacy and clinical prognostic factors for dCRT in locally advanced esophageal cancer. Materials and Methods We conducted a review of patients who received dCRT for locally advanced squamous esophageal cancer from 2004 to 2010, focusing on stages III and IVa. All patients received at least two cycles of platinum-based chemotherapy during radiation, and all tumor burdens were included in the radiation field. The treatment results were analyzed for patterns of failure and prognostic factors associated with survival. Results In total, 63 patients were enrolled in this study. The overall response rate was 84.1%. Relief from dysphagia after dCRT was achieved in 48 patients. The most frequent failure was local recurrence. The median overall survival (OS) was 23.0 months, and the 2-year survival rate was 45.4%. Similar results were observed for elderly study patients. Significant prognostic factors for OS were duration of smoking, high grade of dysphagia (score of 3 or 4), and shorter duration of progression-free and dysphagia-free survival. Maintenance chemotherapy after dCRT did not influence OS. However, “good risk” patients receiving maintenance chemotherapy showed better OS than those who did not receive maintenance chemotherapy (30.4 months vs. 12.0months, p=0.002). Conclusion dCRT has a major role in improving survival and palliation of dysphagia in inoperable advanced esophageal cancer, even in elderly patients. Maintenance chemotherapy after dCRT may be effective in prolonging survival in “good risk” patients.
Abstract
Purpose Locally advanced esophageal cancers are generally treated with neoadjuvant chemoradiotherapy, followed by surgery in operable candidates. However, even if the patients were diagnosed as operable disease, surgery could not be performed on patients with poor condition or other comorbidity. In this case, definitive chemoradiotherapy (dCRT) is the other option for localized esophageal cancer. Therefore, the purpose of this study was to evaluate the efficacy and clinical prognostic factors for dCRT in locally advanced esophageal cancer. Materials and Methods We conducted a review of patients who received dCRT for locally advanced squamous esophageal cancer from 2004 to 2010, focusing on stages III and IVa. All patients received at least two cycles of platinum-based chemotherapy during radiation, and all tumor burdens were included in the radiation field. The treatment results were analyzed for patterns of failure and prognostic factors associated with survival. Results In total, 63 patients were enrolled in this study. The overall response rate was 84.1%. Relief from dysphagia after dCRT was achieved in 48 patients. The most frequent failure was local recurrence. The median overall survival (OS) was 23.0 months, and the 2-year survival rate was 45.4%. Similar results were observed for elderly study patients. Significant prognostic factors for OS were duration of smoking, high grade of dysphagia (score of 3 or 4), and shorter duration of progression-free and dysphagia-free survival. Maintenance chemotherapy after dCRT did not influence OS. However, “good risk” patients receiving maintenance chemotherapy showed better OS than those who did not receive maintenance chemotherapy (30.4 months vs. 12.0months, p=0.002). Conclusion dCRT has a major role in improving survival and palliation of dysphagia in inoperable advanced esophageal cancer, even in elderly patients. Maintenance chemotherapy after dCRT may be effective in prolonging survival in “good risk” patients.
참고문헌 (25)
- Siegel R, "Cancer treatment and survivorship statistics, 2012", CA Cancer J Clin, 62, pp.220~241 (2012)
- Kyu-Won Jung, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2009", Cancer Research and Treatment, 44(1), pp.11~24 (2012), 대한암학회
- Enzinger PC, "Esophageal cancer", N Engl J Med, 349, pp.2241~2252 (2003)
- Cooper JS, "Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). Radiation Therapy Oncology Group", JAMA, 281, pp.1623~1627 (1999)
- van Hagen P, "Preoperative chemoradiotherapy for esophageal or junctional cancer", N Engl J Med, 366, pp.2074~2084 (2012)
- Green FL, "AJCC cancer staging handbook: from the AJCC cancer staging manual" (2002), Springe
- Ogilvie AL, "Palliative intubation of oesophagogastric neoplasms at fibreoptic endoscopy", Gut, 23, pp.1060~1067 (1982)
- Sun DR, "Ten-year follow-up of esophageal cancer treated by radical radiation therapy: analysis of 869 patients", Int J Radiat Oncol Biol Phys, 16, pp.329~334 (1989)
- al-Sarraf M, "Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study", J Clin Oncol, 15, pp.277~284 (1997)
- Steiger Z, "Eradication and palliation of squamous cell carcinoma of the esophagus with chemotherapy, radiotherapy, and surgical therapy", J Thorac Cardiovasc Surg, 82, pp.713~719 (1981)
- Stahl M, "Combined preoperative chemotherapy and radiotherapy in patients with locally advanced esophageal cancer. Interim analysis of a phase II trial", J Clin Oncol, 14, pp.829~837 (1996)
- Tougeron D, "Safety and outcome of definitive chemoradiotherapy in elderly patients with oesophageal cancer", Br J Cancer, 99, pp.1586~1592 (2008)
- Hurmuzlu M, "High-dose definitive concomitant chemoradiotherapy in non-metastatic locally advanced esophageal cancer: toxicity and outcome", Dis Esophagus, 23, pp.244~252 (2010)
- Crosby TD, "Definitive chemoradiation in patients with inoperable oesophageal carcinoma", Br J Cancer, 90, pp.70~75 (2004)
- Liao Z, "Esophagectomy after concurrent chemoradiotherapy improves locoregional control in clinical stage II or III esophageal cancer patients", Int J Radiat Oncol Biol Phys, 60, pp.1484~1493 (2004)
- Minsky BD, "INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy", J Clin Oncol, 20, pp.1167~1174 (2002)
- Yamashita H, "The intergroup", RTOG 85-01 concurrent chemoradiation regimen for Japanese esophageal cancer, 2006, pp.53, 863~868
- Di Fiore F, "Predictive factors of survival in patients treated with definitive chemoradiotherapy for squamous cell esophageal carcinoma", World J Gastroenterol, 12, pp.4185~4190 (2006)
- Muijs CT, "In response to: study to determine adequate margins in radiotherapy planning for esophageal carcinoma by detailing patterns of recurrence after definitive chemoradiotherapy", Int J Radiat Oncol Biol Phys, 75, pp.1623~ (2009)
- Morita M, "In-hospital mortality after a surgical resection for esophageal cancer: analyses of the associated factors and historical changes", Ann Surg Oncol, 18, pp.1757~1765 (2011)
- Shim HJ, "Phase II study of docetaxel and cisplatin chemotherapy in 5-fluorouracil", cisplatin pretreated esophageal cancer, 2010, pp.33, 624~628
- Tomblyn MB, "Cetuximab plus cisplatin, irinotecan, and thoracic radiotherapy as definitive treatment for locally advanced, unresectable esophageal cancer: a phase-II study of the SWOG (S0414)", J Thorac Oncol, 7, pp.906~912 (2012)
- Wakui R, "Esophageal cancer: definitive chemoradiotherapy for elderly patients", Dis Esophagus, 23, pp.572~579 (2010)
- Nakatsu T, "Tumoral CRP expression in thoracic esophageal squamous cell cancers is associated with poor outcomes", Surg Today, 42, pp.652~658 (2012)
- Lin CS, "Prognostic variables in thoracic esophageal squamous cell carcinoma", Ann Thorac Surg, 87, pp.1056~1065 (2009)